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Xformpusher


OrderTypeCDASHIG VariableQuestion TextPromptCRF Completion InstructionsSDTMIG TargetSDTMIG Variable MappingControlled Terminology Codelist NameImplementation NotesPermissible ValuesPre-populated ValueQuery DisplayList StyleHidden
1textTUDATCollection Date
Collection DateTUDTC
N/A


Prompt


2textTULOCWhat was the anatomical region shown by the imaging procedure?Anatomical Part or Region Shown by the Image
TULOC

This is the general anatomical part or region made available for assessment by the imaging procedure.
LOWER LIMB REGION

Y
3textTUTESTWhat was the
lesion
identification test
name?
Lesion
Identification
Test Name
Record the name of the TU
test, if not printed on the CRF.
If collected on the CRF, the
sponsor may provide additional
instructions to ensure the data
is entered as intended.
TUTEST
(TUTEST)Required to identify to which test the result relates. It is
recommended that test names be preprinted on the CRF rather than

collected in a field that requires the site to enter text. If the form is

laid out as a grid, then words such as Test can be included as the

column header.
Lesion
Location Identification
Indicator

Y
3What was the
location of
the lesion

4textTUORRES
ResultTUORRESN/AIdentifiedY4textTURESLOC
Was there a lesion present based on the assessment of the image?
Result Anatomical LocationTURESLOC when TUTEST = Lesion Location Identification(LOC)5textTURESLATIf applicable, what
was the laterality
of the anatomical
location?Result Location LateralityTURESLAT when TUTEST = Lesion Location Identification(LAT)6textTURESLDLIf applicable, provide further details of the locationResult Location directionality
Presence of Lesion
TUORRES
(Y/N)
Yes;No
redio


5
TURESLDL when TUTEST = Lesion Location IdentificationN/A7textTULNKIDWhat was the
Lesion ID?Lesion IDSponsor-specifiedTULNKID, TRLNKID, RSLNKIDN/AThis variable is used to provide a unique code for each identified lesion in order to link records across related domains (TU, TR, RS).2
Xformpusher
OrderTypeCDASHIG VariableQuestion TextPromptCRF Completion InstructionsSDTMIG TargetSDTMIG Variable MappingControlled Terminology Codelist NameImplementation NotesPermissible ValuesPre-populated ValueQuery DisplayList StyleHidden1textTUDATCollection DateCollection DateTUDTCN/APrompt
textTUTESTWhat was the
lesion
identification test
name?
Lesion
Identification
Test Name
Record the name of the TU
test, if not printed on the CRF.
If collected on the CRF, the
sponsor may provide additional
instructions to ensure the data
is entered as intended.
TUTEST
(TUTEST)Required to identify to which test the result relates. It is
recommended that test names be preprinted on the CRF rather than

collected in a field that requires the site to enter text. If the form is

laid out as a grid, then words such as Test can be included as the

column header.
Lesion Location Identification

Examination for Abnormality

Y
3

6textTUORRES
ResultTUORRESN/AIdentifiedY4
What was the type of lesion observed based on the assessment of the image?Lesion TypeRecord the type of lesion observed, e.g. aneurysm, calcified annulus, valvular stenosis, etc.TUORRES when TUTEST = ABNEXAM




Prompt


7textTURESLOCWhat was the
location of
the lesion based on the assessment of the image?
Result Anatomical LocationIf this location is a graft (or transplant), enter the name of the native tissue, organ or blood vessel on which the graft is built (or in which the transplant is implanted).TURESLOC when TUTEST =
 Lesion Location Identification(LOC)5
 ABNEXAM
(LOC)






8textTURLGFFLIndicate whether the located lesion is in a graft or transplant.Graft Result Location FlagCheck "Yes" for this question if the lesion is located in a graft (or transplant) tissue, organ or blood vessel.NSTU.TURLGFFL


Yes

checkbox




9textTURESLATIf applicable,
what
was
indicate the laterality

of the
anatomical
location?
location of the lesion.Result Location Laterality
TURESLAT when TUTEST =
 Lesion Location Identification
 ABNEXAM
(LAT)
6







10textTURESLDLIf applicable, provide
further details
more detail of the location of the lesion.Result Location directionality
TURESLDL when TUTEST =
 Lesion Location Identification
 ABNEXAM
N/A
7







11textTULNKIDWhat was the
Lesion ID?
Lesion IDSponsor-specifiedTULNKID, TRLNKID, RSLNKID
N/AThis variable is used to provide a unique code for each identified lesion in order to link records across related domains (TU, TR, RS).